“Broadly speaking, these are our goals for vaccination,” Lamont said. “Get as many people vaccinated as we possibly can ... and complement that with equity, knowing full that our Black and brown population here in this state and around the country are twice as likely to suffer complications from an infection and half as likely to get vaccinated.”
But experts are divided on whether the new strategy will truly accomplish those goals — and particularly whether it will truly maximize equity. While state and hospital officials say this plan, which establishes priority groups almost strictly by age, will create a smoother, faster rollout, skeptics worry the new eligibility guidelines are not as inclusive as those the Lamont administration jettisoned.
“It’s really hard to see how we are addressing the exponential exposure and risk that people of color are facing in our state,” said Tekisha Everette, executive director of Health Equity Solutions and a member of the state’s vaccine allocation subgroup. Under the old plan, frontline essential workers and people with underlying health conditions would have been the next groups eligible for vaccination. Under the current plan, people over age 55 will be eligible March 1, followed by people over age 45 on March 22, over age 35 on April 12 and over age 16 on May 3. The new plan also carves out special priority for educators.
State officials say the new strategy, which stands in opposition to guidance from the U.S. Centers for Disease Control and Prevention, is an acknowledgement of logistic realities.
“The CDC was obviously focused on the medical risks, the public health considerations for specific groups,” said Josh Geballe, the state’s chief operating officer. “They did not get into how you operationalize those recommendations.”
About 17 percent of Connecticut residents have received at least one dose of the COVID-19 vaccine, which requires two shots. Thus far, Connecticut ranks among the states that have vaccinated the highest share of residents.
Speed
Hospital officials say that the state’s new guidelines are much clearer and easier to implement than the old guidelines, which would’ve tasked health providers with parsing CDC eligibility guidance and potentially overwhelmed medical practices with requests for doctor’s notes.Jeffrey Flaks, the CEO of Hartford HealthCare, said Monday that age was “the most manageable criteria” for the health system.
Dr. Jim Cardon, Hartford HealthCare’s chief clinical integration officer, said implementation will be easier under an age-based system.
“The question is, how do you operationalize this thing to make this all make sense,” Cardon said. “There are some practicalities around it that I think the state is working with to try to do this in an organized fashion so we’re not stumbling into ourselves.”
Dr. Thomas Balcezak, Yale New Haven Health’s chief clinical officer, agreed but also noted that the simpler process likely won’t speed up vaccinations immediately. Right now, the bottleneck is not the process itself, but the number of doses that the state is receiving from the federal government.
“I don’t think we can speed up any more than we already are,” Balcezak said. “We’re going as fast as we need to, given how much vaccine we’re getting.”
When the state does receive more doses, Balcezak said, then the efficiency of the new rollout could pay some dividends.
Connecticut’s age-based rollout is slated to open to the general population by May 3 — months earlier than the original plan’s estimate that vaccinations would open to the general population in late summer or early fall.
But that much-quickened timeline is not due only to the simpler categorizations. The new timeline also accounts for considerably increased supply estimates from the federal government, which would have sped up the timeline no matter what process the state followed.
Geballe said the speedier timeline is mostly a result of the changing supply estimates — not the new rollout itself.
“When we put those initial estimates out, we had very little visibility into how vaccine delivery to the states was going to scale up over time,” Geballe said. More extended forecasting “gives us a lot more clarity and confidence about the vaccine supply that we should be able to count on that should enable us to work through the full population much quicker.”
Geballe said that the state did not run estimates of how quickly the old rollout plan could have been accomplished on the increased supply estimates. Because of that, it remains unclear how much faster the new rollout actually is, independent of the increased supply of vaccine doses.
But the ease of communicating and implementing the new rollout criteria — compared with the difficulty of the old rollout criteria — make a clear argument, he said.
“I think common sense indicates that it would be faster,” Geballe said.
Equity
In defending the age-based plan, Lamont administration officials point to data that shows the vast majority of COVID-19 deaths are older people.“The people who are most at risk in the Black and brown community, it still correlates by age,” Geballe said. “So working backwards by age will most rapidly be able to provide access to everybody who’s most at risk for severe illness or death, regardless of race or ethnicity.”
In that way, Geballe said, the new approach will help all populations, including — if not specifically — low-income, Black and Latino residents.
State officials also argue that the ease of sorting by age will create more equal distribution of vaccine during the coming phases.
“When you’re talking about a complex process, for anything, who does that favor at the start?” said Max Reiss, a Lamont spokesperson. “It favors people with time, resources, technology, possibly connections, but definitely easy access to health care. So the more complex the process, the more likely that those that have all those things will find their way to the front of the line, and those who don’t have those things get left behind.”
Prioritizing essential workers and people with underlying conditions might have meant requiring confirmation from employers and doctors. Age, on the other hand, can be verified quickly and easily.
Monika Lopez-Anuarbe, a professor of economics at Connecticut College with a focus on health equity, said that argument makes sense in theory — but she disagreed that the correct conclusion was to forego the complex process entirely.
“The theoretical part does say that the health care system has all of these asymmetries and barriers,” Lopez-Anuarbe said. “But that doesn’t mean that we should give up. ... You can’t just say, ‘It’s too complicated and we can’t do it.’”
As Reiss acknowledged Wednesday, even if distribution among people aged 55 to 64 is more equitable under an age-based system, that group is likely whiter than a group including essential workers and people with underlying health conditions, who are disproportionately Black and Latino.
In fact, state data from 2019 shows the 55- to 64-year-old population to be considerably whiter than Connecticut’s general population.
Lopez-Anuarbe said she’s in favor of a simpler process, so long as there’s still an acknowledgement that different groups of people have different risks. Not every 20-year-old is the same, Lopez-Anuarbe said; age is not the only factor.
“I am proud ... that we are learning and applying what we’re learning at a faster rate than other states. We’re not perfect but at least it’s not an inflexible system,” she said. But “it’s just not enough from an equity point of view.”
Everette, of Health Equity Solutions, called Lamont’s new strategy “disheartening.” In her view, an equitable plan would prioritize people with underlying conditions and also target particular geographic areas.
A geographic approach, she said, would be both equitable and efficient, without the need for a complex verification process.
“Find the spaces where things are the worst, where people are vulnerable,” Everette said. “Target there and move your vaccine process outward.”
Everette said she and other members of the vaccine allocation subgroup were not consulted directly on Lamont’s new plan and that she learned of it only minutes before it was officially announced Monday afternoon. She said she hopes the governor will eventually change direction once again.
“I’m just hopeful that this redirection isn’t a final one,” she said, “and that if we find, which some of think to be true, that this redirection is going to lead us to deeper and worse inequities that we’re able to pivot again and this time to something that will get us to health equity.”
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